Ischemic Colitis

Ischemic colitis (ischemic disease of the colon) was first described in 1966. It occurs when there is an occlusion of branches of the superior mesenteric (SMA) or inferior mesenteric arteries; the vast majority of cases describe the lesion in the splenic flexure and left colon. This severe illness is very common among the elderly with pronounced cardiovascular disorders. An acute stabbing abdominal pain and rectal bleeding with diarrhea in most of the cases follow the onset. Ischemic disease of the colon requires immediate actions; the sooner the treatment is administered, the more benign the outcome is.

00:01
Ischemic colitis.
00:02
As the name implies, this will be issues with the vascular system.
00:07
The patient is gonna present with abdominal pain and rectal bleeding,in the setting of decreased perfusion,in a background of chronic diffuse mesenteric vascular disease.
00:19
We'll get into further detail with the mesenteric ischemiaand the different or probable pathogenesis,but at this point understand that due to the ischemia,you will have issues with intestine in which the patient is going to present with rectal bleeding.
00:37
Remember this is a red type of infarct because we have two more blood suppliestaking place with the colon. Accompany dehydration, sepsis and hypertension.
00:47
You are worried about sepsis here with ischemia.
00:51
Quite dangerous and more or less an emergency type of matter,commonly involves the watershed area, if you remember that watershed would be that areaor tissue in which you would have one and two vascular systemsthen supplying or perfusing that tissue. If one goes out, then the other one will take overresulting in hemorrhage into. That is watershed.
01:14
Radiographically the feature here that I show you is 'thumbprinting'.
01:20
And your management here would be supportive care with IV fluidbecause you're worried about loss of fluid and because of loss of fluidblood pressure control is important and antibioticsbecause here you are dealing with ischemic colitis.
01:36
On your left is your normal colon and then on the right is representative of ischemic colitis,the arrows are then pointing to your 'thumbprinting'.

About the Lecture

The lecture Ischemic Colitis by Carlo Raj, MD is from the course Small and Large Intestine Diseases.

Included Quiz Questions

Which disease is prone to occur in the watershed areas of the colon?

Ischemic colitis

Inflammatory bowel disease

Irritable bowel syndrome

Colon cancer

Diverticulitis

What feature on a contrast x-ray is associated with ischemic colitis?

Thumbprint appearance

Bird beak sign

Rat tail appearance

Double bubble sign

Donut sign

Which of the following is an example of a watershed area of the colon?

Splenic flexure

Ileocecal junction

Ascending colon

Transverse colon

Anus

Which kind of infarct is seen in ischemic colitis?

Red infarct

White infarct

Wedge-shaped infarct

Lacunar infarct

Pale infarct

Author of lecture Ischemic Colitis

Carlo Raj, MD

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